Sports Injuries

15
May

How To Deal With Acute Joint and Back Pain.

What do you do when faced with acute joint pain?

If it is due to a traumatic incident it is best to call for medical assistance as you need to ascertain if anything is broken.

This following advice is meant as a guide and you should seek advice for your particular problem.

Assuming it is due to an unguarded movement (by that we mean the muscles didn’t support your joint) the best thing to do is get a flexible ice pack over the painful joint. This must be wrapped in a thin cloth to protect the skin from a burn. The length of time depends on the depth of the joint.

As a general rule do 10 mins for neck, upper back and limbs and 20 mins for lower back. Try to apply 3-4x a day, mainly from mid morning onwards. You will probably feel best having a hot shower in the morning to loosen the overnight stiffness.

The next important thing to do is stay mobile on a regular basis if possible. This may be difficult to do initially. However as you move you will inhibit pain, so start gently and gain flexibility slowly. Do not test your movement in the direction of pain, as it will only aggravate your condition.

You would as a general rule benefit by going into the pain free direction. Please note with sciatica due to a disc prolapse you go into the direction that reduces leg pain even it the back aches a little. Please see the section on sciatica for further information.

22
Apr

Orthotics or anti pronation running shoes?

Orthotics or Anti-pronation running shoes for those flat feet?

First Lap Of An Ironman

In practice we are asked whether anti-pronation running shoes or orthotics are the best option for runners. This article will help you to understand pronation and guide you in your choice of running shoes to prevent over pronation.

What Is Over Pronation?

Pronation describes the rolling in of the foot as it strikes the ground during walking or running. This rolling in is part of the normal mechanics of the foot. It allows the foot to absorb energy efficiently and reduce the impact forces up the leg and into the rest of the body.

For some people the foot will pronate too far, too fast or both. These situations will give rise to increased risk of injury as the impact forces will be greater and the stress on the supportive structures (muscles and ligaments) of the leg and low back will be increased.

Do This exercises to understand the mechanics better.

  1. Stand up wearing shorts, place your hands on your hip bones at the front and roll your legs inwards, what happens to your the position of your hands? You will find them tilt forwards, your knees will also rotate inwards as your arches drop flatter.
  2. Now raise your arches by rotating your feet outwards at the ankle. Notice how the knees rotate out and the pelvis tilts backwards.
  3. Now try it the other way round. Stand and focus on the pelvis. Rotate it forward and see what the feet do. You will see them pronate.
  4. Rotate or tilt the pelvis backwards and you will see them supinate (increase the arch).

From this you can get a picture of what is happening to the movement of the joints in the leg. This is called a kinematic chain as it describes a chain of movement.

Tackling Pronation

Go to any running shop and pronation will be on the radar. Since the 80’s running foot wear has been developed to help cushion and stabilise feet and pronation has been seen as the enemy. This approach sprang up following research that linked over pronation to running injuries. Further research corroborated this and manufacturers responded to prevent pronation. This lead to various approaches to aid stability at the ankle. The footwear had increased arch supports or a cant to change the angle of impact or both. This lead to a heavy and bulky shoe.

However, it is important to remember that the foot is supposed to pronate as part of shock absorption and normal mechanics to allow the foot to flex during the heel strike to toe off phase of gait. Stopping this is equivalent to trying to run on a stiff leg or stump. That is not going to help your prevent injury and may even make things worse. So it is important to maintain a balance that reduces excessive pronation and slows its rate if you roll in too fast.

Runners with feet that over pronate will generally need an anti-pronation shoe or an orthotic, runners that have high arches (supinate) will need a better padded shoe.

New Thinking on How Anti-pronation works.

In 2001 Benno Nigg (1) proposed a new way of thinking on how these measures work. Rather than assume that they changed the position of the foot he postulated that they changed the pattern of firing of the muscles of the leg. This then created the stabilisation and slowing of pronation. This makes perfect sense as it is the firing of muscles in a coordinated fashion that stabilises and moves a joint. However as we saw in the exercise earlier the knee, hip and pelvis position also affect the ankle. So in order to achieve good ankle stability you also need top strengthen them.

A key muscle in this process are the Gluteal muscles. They stabilise the hip when you stand on one leg stopping the pelvis from dropping forwards on that side. Remember as the pelvis drops forwards it rolls in your ankle.

So in summary, if you want to run well, get your pronation assessed, select the appropriate stabilisation and strengthen the muscles around the hip, knee and ankle by following these exercises.

What Do We Recommend?

You may now be able to guess what I recommend to help the problem. In my opinion an orthotic in a neutral shoe is a good option. HOWEVER, it needs to be the right type. It should have an arch that is free to spring and not be a solid inflexible device such as the moulded bespoke carbon or plastic varieties that have little or no give in them.

Similarly it shouldn’t be a foam based orthotic that fills the arch up. Now if you look at the anti-pronation shoes they basically tilt or cant the shoe to take out some of the roll. The problem with this is the lack of spring but also you have a clumpier, heavier shoe to carry round for your 40000 steps. That extra bulk and weight will have an effect after that many reps.

At Back In Form we recommend SOLE orthotics as they give the spring required and they are relatively inexpensive when compared to tailored orthotics. If you’d like us to assess you or for more information on how you can save over 10% off RRP just call us on 01202 733355.

 

  1. Nigg, BM. 2001. ‘The role of impact forces and foot pronation: a new paradigm’. Clin J Sport Med. 11 (1): pp 2–9.

 

 

21
Apr

Is Your Posture Saying Something About Your Brain?

Poor posture can be a sign that there is a weakness in your brain function.

Take a look in a full length mirror at yourself and see if the following applies to you.

A commonly seen aberrant posture in clinic is one where your foot is turned out, the arm on the same side is held slightly flexed at the elbow and is rotated inwards so that you can see more of the back of the hand than the other side when looking face on. The same shoulder will also be held forwards. Typically this is due to weakness of the anti-gravity muscles down one side of the body and is a milder presentation than Pyramidal Weakness found in some typical stroke patients.

The anti-gravity postural muscles hold the shoulder back and rotate the arm outwards. They also lift the leg and foot from the floor. Commonly this pattern of weakness leads to rotator cuff problems, tennis elbow, hip pain, shin splints etc. If you have had any of these problems or get them repeatedly despite having had treatment then you possibly have a functional weakness of a relay area in the brain called the Ponto-Medullary-Reticular-Formation or PMRF for short.

You can have as much Physiotherapy, Chiropractic, Osteopathy or whatever other therapy you like, but if the weakness is established the problem will keep recurring. Why? Because the brain will keep pulling you into the poor posture. If you are exercising and getting stronger you will have less symptoms, but push it hard and you’ll be likely to get your injury again. This is because the area in the brain will fatigue one side faster than the other and your control will diminish. The result, yet another injury. Just think how many sports people have struggled through their careers with hard to treat injuries. The list is endless.

By specifically treating to enhance function in this area we can help to restore normal function. If we combine this with visual exercises we can help to hard wire the pathways to strengthen them. This requires repeated stimulation over a short period to get the nerves to express genes that lead to growth of new connections. It won’t happen without repetition.

So if you’ve ever had a car accident or a whiplash type injury from sports such as horse riding, skiing, boarding and obviously boxing then you may be prone to these problems. If you’ve ever had a concussion or been knocked out the chances of this are significantly increased.

Make sure you find someone who can look at these patterns to help you for the longer term and not just a quick fix.

2
Nov

Longer Term Use Of Cortico-steroids For Tendinopathies Worse Than No Treatment At All.

GPs are being advised to only use short courses of steroid injections to treat tendinopathies, after a systematic review found using them for longer can produce worse results than no treatment.

Instead they are being advised to use other methods of non-steroidal injections for treatment such as botulinum toxin and hyaluronic acid for conditions such as tennis elbow and other tendinopathies.

The extensive review – published in The Lancet – looked at 41 trials involving 2,672 patients and estimated the standardised mean differences between treatments and placebo.

Steroid administration was shown to be consistently effective over the short term but long term the benefit was unclear. For further information the full article can be found here, and the actual paper is here. Read more

“There is a high risk of poor long-term outcomes and higher recurrence rates with corticosteroid injections,” said lead author Bill Vicenzino, chair of sports physiotherapy in the School of Health and Rehabilitation Sciences at the University of Queensland.

“Other treatments, including exercise, some specific physiotherapy and possibly some other injections, should be used before corticosteroid injections,” Vicenzino said.

A Role For Medical Acupuncture?

critical review by L.Viola of the literature showed some evidence of increased effectiveness of medical acupuncture over steroid injection, however the study sample quoted was limited and further research is required with larger samples.

 

study by Val Jones published in Shoulder and elbow concluded that Acupuncture is frequently used by Chiropractors, physiotherapists in the management of chronic tennis elbow . However, the very few acupuncture studies to date have failed to prove conclusively that the short term relief in pain seen gives rise to long term functional improvement. No trials to date have assessed, concentrated or commented on the potential adverse effects of this particular form of treatment. The most recentCochrane review concludes there is insufficient evidence to support or refute the use of acupuncture. Further trials utilizing appropriate methodology and adequate sample sizes are needed before firm conclusions can be drawn regarding this treatment modality.

So Can Acupuncture Help?

In my opinion which is based solely on anecdotal cases, there is definitely a role for medical acupuncture in relieving short-term pain over general soft-tissue therapy alone. However it is likely that the combination of supportive taping, clasps, acupuncture, ice and heat therapy plus mobilisation and manipulation is probably the best route of care. This is due to the stimulation of repair, control of inflammation and restoration of accurate controlling reflexes.

From a personal view point just today I have been self administering acupuncture for a strain on my very own Tennis elbow, now I have to be disciplined and not play tennis tonight, pity as I was just starting to perfect my top-spin forehand, (probably wasn’t perfected, hence the injury). Physician heal thyself!!